Literature Review

UnitedHealth Group's year of DOJ probes, layoffs and backlash Modern Healthcare; by Lauren Berryman; 2/24/25 UnitedHealth Group has faced an unprecedented past year, navigating events that have tested its finances, operations and reputation. Here is a timeline of key events during the company’s past 12 months. [Click here and scroll down to the timeline with links to Modern Healthcare's articles through the year.]

Saad Healthcare agrees to pay $3M to settle False Claims Act allegations that it billed Medicare for ineligible hospice patientsU.S. Department of Justice - Office of Public Affairs; Press Release; 2/21/25Saad Enterprises Inc., doing business as Saad Healthcare, has agreed to pay $3 million to resolve allegations that it violated the False Claims Act by knowingly submitting false claims for the care of hospice patients in Alabama who were ineligible for the Medicare hospice benefit because they were not terminally ill. ... The settlement resolves allegations that between 2013 and 2020 Saad submitted, or caused the submission of, false claims to Medicare for 21 patients who did not meet the eligibility requirements for the Medicare hospice benefit as defined by statute and regulation, despite Saad knowing the patients were ineligible for the Medicare hospice benefit.

New Day Healthcare acquires Christian Senior Care Services  Hospice News; by Jim Parker; 2/20/25 New Day Healthcare has acquired the home-based care company Christian Senior Care Services in Houston for an undisclosed sum. The deal, New Day’s 13th to date, expands the company’s personal care services division into five additional counties in the Houston metro area. The operation will continue to operate under its current brand, and the entire staff will remain in place. ... The transaction adds personal care services to New Day’s hospice and home health operations in the Houston area, a key step in the provider’s efforts to build out a multi-faceted continuum of care. ... Similar to national demographic trends, a growing aging population is driving demand for hospice in Texas. Seniors 65 and older represent 13.8% of the Lone Star State’s overall population, according to the U.S. Census Bureau.

What's keeping CFOs up at night? Becker's Hospital CFO Report; by Alan Condon; 2/14/25 As health system CFOs chart their course for 2025, they face an increasingly complex financial landscape marked by mounting labor costs, tightening margins, shifting payer dynamics and an evolving regulatory environment. ... [Several] CFOs recently joined the “Becker's CFO and Revenue Cycle Podcast” to discuss the trends they're watching most closely — and the strategies they're deploying to stay ahead. [Key items include the following: labor shortages (key theme); major investments in ambulatory care facilities; AI to support operations and service; physician partnerships; shift from fee for service to value-based care; clinical labor; malpractice litigation; growth of Medicare Advantage programs; staffing shortages; inflation; reimbursements; providing care to undersinsured patients; Medicaid supplemental funding programs; "disruptors' by private equity and "other nontraditional players"; uncertainty of federal and state regulation changes.]

UnitedHealth, Amedisys plan divesture of up to 128 locations Modern Healthcare; by Diane Eastabrook; 2/11/25 UnitedHealth Group said in a court filing Friday [2/7/25] its plans to sell at least 128 home health and hospice locations to ease the Justice Department's antitrust concerns around its acquisition of Amedisys. The divestiture plans were part of a filing in the United States District Court for the District of Maryland in a response to the Justice Department’s lawsuit to block the proposed acquisition. ... The company didn’t identify which locations would be sold, but said they would be in areas where UnitedHealth Group and Amedisys’ combined market share would exceed the thresholds federal regulators allege could harm competition. UnitedHealth Group said in the court filing it was in the process of identifying qualified buyers who would be able to operate and grow the divested locations.

St. Croix Hospice opens new location in La Crosse News 8 Now, La Crosse, WI; by Corey Peters; 2/12/25 St. Croix Hospice held a ribbon cutting for their new location in La Crosse on Wednesday. St. Croix Hospice originated back in 2009 in Oakdale, Minnesota, and have now expanded to 18 locations around Wisconsin. St. Croix Hospice held a ribbon cutting for their new location in La Crosse on Wednesday. St. Croix Hospice originated back in 2009 in Oakdale, Minnesota, and have now expanded to 18 locations around Wisconsin.

Hospice advocates push bill for a third time despite two Hochul vetoes Spectrum News 1, New York State; by susan Arbetter; 2/12/25 Last spring, Capital Tonight sounded an alarm about for-profit hospice care. The Federal Bureau of Investigation (FBI) had just issued public warnings about for-profit hospice fraud in four states; it was alerting consumers to a scam in which patients were being enrolled without their knowledge by recruiters who were “selling” hospice to people who weren’t eligible. Hospice fraud like this has also been extensively reported by The New Yorker and Pro Publica. After Gov. Kathy Hochul twice vetoed a bill preventing the expansion of for-profit hospice in New York, a new bill (S.3437/ A. 565) is being introduced by the chair of the state Senate Finance Committee, Liz Krueger, and chair of the state Assembly Health Committee, Amy Paulin. “If a family is faced with a loved one that is dying, they should not also be faced with the possible incentive of money,” Assembly member Paulin told Capital Tonight. There are a variety of drawbacks to for-profit care, and there is clear data that shows profit motives drive for-profit hospice to neglect patient care and prioritize volume over quality.

How the DOJ-UnitedHealth Group lawsuit could change hospice M&A Hospice News; by Jim Parker; 2/11/25 A U.S. Justice Department (DOJ) victory in its lawsuit to block UnitedHealth Group’s (NYSE: UNH) acquisition of Amedisys is unlikely to have a cooling effect on hospice M&A, according to some experts. The UnitedHealth Group subsidiary Optum in June 2023 agreed to acquire Amedisys in a $3.3 billion deal. Optum in February 2023 also acquired the home health and hospice provider LHC Group for $5.4 billion. DOJ in December 2024 filed the lawsuit to kill the deal. The state attorneys general of Maryland, Illinois, New Jersey, and New York are also plaintiffs in the suit. ... DOJ’s chief concern is that the combination of the two companies would dampen competition in the hospice and home health space. Should the transaction proceed, Optum would control 30% or more of the home health or hospice services in eight states, according to the Justice Department’s complaint.

Bristol Hospice acquires St. Agatha Comfort Care Hospice News; by Jim Parker; 2/6/25 Bristol Hospice has acquired St. Agatha Comfort Care in Las Vegas for an undisclosed amount. ... Bristol is a portfolio company of the private equity firm Webster Equity Partners. The company operates 64 locations across 25 states, employing more than 3,000 professionals. The hospice provider has indeed been on a growth trajectory. In June 2024, Bristol Hospice acquired Mississippi-based Mid-Delta Hospice, a move that marked its entry into that state. Bristol has been a prolific buyer in the M&A market during the past five years, but more recently it has leaned harder into its de novo strategy. In August of last year, Bristol Hospice opened four new locations within a single week in three different states.

Man pleads guilty in connection with $17m Medicare hospice fraud and home health care fraud schemes Office of Public Affairs - U.S. Department of Justice; Press Release; 2/3/25A California man pleaded guilty today to health care fraud, aggravated identity theft, and money laundering in connection with a years-long scheme to defraud Medicare of more than $17 million through sham hospice companies and his home health care company. According to court documents, Petros Fichidzhyan, 43, of Granada Hills, engaged in a scheme with others to operate a series of sham hospice companies. Fichidzhyan, along with co-schemers, impersonated the identities of foreign nationals to use as the purported owners of the hospices — including using the identities to open bank accounts and sign property leases — and submitted false and fraudulent claims to Medicare for hospice services that were not medically necessary and not provided. In submitting the false claims, Fichidzhyan and his co-schemers also misappropriated the identifying information of doctors ... [Click on the title's link to continue reading.]

Polsinelli attorney: Expand access to capital for hospice, health care providersHospice News - Executive Perspectives; by Jim Parker; 1/28/25 Private equity in health care has come under fire in recent years, but the regulatory environment leaves few other options for raising capital. This is according to Bobby Guy, an M&A attorney and shareholder in the law firm Polsinelli. Guy posits that regulation of publicly traded markets have pushed business owners towards private equity and reduced transparency when it comes to corporate funding. ... The question should not be whether PE is good or bad for health care. The question should be, “How are we going to fund health care?” That’s the real question.Editor's note: This is an "Executive Perspective." Adding another perspective, I invite you to apply this proposed "real question" across the board to all potential payment sources. Are fraud and abuse payments ok, as long as they pay the bills? When you are dying--whether in hospice or not--will the quality of health care you receive matter? If the hospice patient is your child, your spouse, your parent, does the "good or bad" of the health care provided matter? I do not determine the answers for you. I re-ask the question, inviting readers to examine (1) the core purposes and values of hospice care and (2) its expansive body of clinical research data. 

Hospice rationale should be reassessed, says ethicist Medscape; by Arthur L. Caplan, PhD, Medical Ethics at NYU’s Grossman School of Medicine; 1/23/25 ... Decades ago, I first found out about the idea that came from England and a nurse, Cicely Saunders, to change the setting in which people die. ... I think that was a wonderful idea, and it has revolutionized end-of-life care. We have many excellent, superb hospice programs. ... The hospice institution is decades old, and it’s time to take another look at what’s going on there.  ... Private equity is all over this area, buying up hospice chains and home care hospice — looking to make big profits but not looking to maintain the quality requirements that ought to be there or to do more than is minimally required to set up and staff hospice. ... ... For reasons of serving the best interests of hospice patients, we should be rechecking the fairness of reimbursement, not overburdening families with care that ought to be provided by hospice programs, and making sure that those who are dying are monitored adequately and receiving checkups regularly. ...

Federal report highlights private equity, consolidation concerns Modern Healthcare; by Hayley Desliva; 1/16/25 Three federal agencies on [1/15/25] said "more effective and vigorous" enforcement is needed to protect patients harmed by healthcare's continued consolidation. In a report released just days before a new administration takes over, the Health and Human Services Department, Federal Trade Commission and Justice Department said comments they sought earlier this year on the state of the industry made clear that worries about access to services and costs have intensified as consolidation and private equity's role have grown. ... The report noted several areas of concern: